Provider Demographics
NPI:1689659633
Name:HOUCK, LISA PERKINS (PT, DPT, OCS, MTC)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:PERKINS
Last Name:HOUCK
Suffix:
Gender:F
Credentials:PT, DPT, OCS, MTC
Other - Prefix:DR
Other - First Name:LISA
Other - Middle Name:MICHELE
Other - Last Name:PERKINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, DPT, OCS, MTC
Mailing Address - Street 1:610 SOLAREX CT
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21703-8624
Mailing Address - Country:US
Mailing Address - Phone:240-215-9023
Mailing Address - Fax:
Practice Address - Street 1:610 SOLAREX CT
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21703-8624
Practice Address - Country:US
Practice Address - Phone:240-215-9023
Practice Address - Fax:240-215-9026
Is Sole Proprietor?:No
Enumeration Date:2005-12-13
Last Update Date:2009-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD20195208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD147719000OtherDOL FSS
MD2116439OtherMAMSI FSS
MD3116439OtherMAMSI MSS
MD334552OtherPHCS
MD611844-02OtherCAREFIRST MSS
MDK134-0001OtherBC FEP MSS
MD650022015OtherMC RR
MD6611844-01OtherCAREFIRST FSS
MD602030700OtherDOL MSS
MHR5590004OtherFSS BC FEP
MD3116439OtherMAMSI MSS
MD650022015OtherMC RR
MD334552OtherPHCS